ANNEXURE-II

1.
2.
3.
4.

Form for sending particulars of income under section 192(2B) for the
year ending 31st March, 2015
Name and address of the employee
Permanent Account Number
Residential status
Particulars of income under any head of income other than "salaries" (not being a loss
under any such head other than the loss under the head "Income from house
property") received in the financial year 2014-15
(i)

Income from house property

(in
case
of
loss,
computation thereof)

(ii)

_____________________________
enclose

Profits and gains of business or _____________________________

profession

(iii) Capital gains

(iv)

Income from other sources

(a) Dividends
(b) Interest
(c) Other incomes (specify)
Total

_____________________________

5. Aggregate of sub-items (i) to (iv) of item 4

6. Tax deducted at source (enclose certificates) issued under section 203)
Place _____________________
Date _____________________

_________________________
Signature of the employee
Verification

I, ___________________________, do hereby declare that what is stated above is true to

the best of my Knowledge and belief. Verified today, the _________day of __________,
Place _________________
Date _________________

___________________________________
Signature of the employee